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Business Insurance Quotation Form

*indicates Required Fields

Full Name*

   
Email Address
   
Years Trading*
   
Business Address*
   
Description of Trade / Business*
   
   
   
       
  Have you made a claim or suffered loss or damage at your business premises within the last 3 years?*  
       

       
  Have you ever had any insurance policy cancelled or refused or have been asked to pay an increased premium?*  
       

       
  Have you ever been convicted of any offence involving dishonesty, fraud, violence, criminal damage, arson, drugs or have such a prosecution pending?*  
       

       
  Do you undertake work away from the prmises you operate from apart from delivery of goods?*  
       

       
  Does any other business occupy or operate from your premises?*  
       

       
 

If the answer is yes to any of the above questions, please provide full details:

 
       

 

Security

       
  Are all the premises you operate from occupied during normal business hours?*  
       

       
  Does each premises you operate from have its own seperate lockable entrance?*  
       

       
  Are all door and window openings on the ground floor of each premises secured by solid wooden apertures or grille or metal shutters?*  
       

       
  Do you a have a burglar alarm installed at the premises you operate from?*  
       

       
  Do you have a CCTV system installed at your premises?*  
       

       
  Do you have fire extinguishers installed at the premises which are regularly serviced and maintained?*  
       

       
  Do you have a safe installed at your premises?*  
       

Cover on Property

       
  Would you like to insure your buildings?*  
       
     
If Yes, please input Sum Insured:
       

       
  Would you like to insure your furniture and fittings?*  
       
     
If Yes, please input Sum Insured:
       

       
  Would you like to insure your computers and business equipment?*  
       
     
If Yes, please input Sum Insured:
       

       
  Would you like to insure your stocks?*  
       
     
If Yes, please input Sum Insured:
       

       
  Would you like to insure your pland and machinery?*  
       
     
If Yes, please input Sum Insured:
       

Business Interruption

       
  Would you like to insure a possible interruption to your business?*  
       

       
 

What is your estimated annual gross revenue?

 
       

 

Liability Insurance

       
  Would you like to insure your liability towards third parties?*  
       

       
 

What is your annual turnover?

 
       

       
  Would you like to insure your liability towards your employees?*  
       

       
 

How many employees do you employ?

 
       

       
 

How much do your annual wages amount to?

 
       


Additional Cover

       
  Cover for accidental damage to Buildings & Contents*  
       
     
If Yes, please input Sum Insured:
       

       
  Cover for accidental damage on Glass, Mirrors, Signs and Sanitary ware*  
       
     
If Yes, please input Sum Insured:
       

       
  Cover on Portable Business or Computer Equipment*  
       
     
If Yes, please input Sum Insured:
       

       
  Theft of cash from the premises or whilst in transit*  
       
     
If Yes, please input Sum Insured:
       

       
  Cover for Stock whilst in Transit*  
       
     
If Yes, please input Sum Insured:
       

 


Contact Details

These details will be only used by our Sales Representatives to contact you regarding this quotation.

Contact Number*
 
Preferred Calling Time
Between:    
and
   
   

 
 
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